Provider Demographics
NPI:1376959072
Name:ST THOMAS DENTAL GROUP INC
Entity Type:Organization
Organization Name:ST THOMAS DENTAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:N
Authorized Official - Last Name:SARIKAKIS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:209-383-5200
Mailing Address - Street 1:1208 PASEO VERDE DR
Mailing Address - Street 2:
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95348-1841
Mailing Address - Country:US
Mailing Address - Phone:209-383-5213
Mailing Address - Fax:209-383-5700
Practice Address - Street 1:936 W MAIN ST
Practice Address - Street 2:
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95340-4519
Practice Address - Country:US
Practice Address - Phone:209-383-5200
Practice Address - Fax:209-383-5700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-02
Last Update Date:2014-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty